Increasing incidence of withholding and withdrawal of life support from the critically ill
Increasing incidence of withholding and withdrawal of life support from the critically ill
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DOI：
10.1164/ajrccm.155.1.9001282
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发表时间：
1997-01-01
影响因子：
24.7
通讯作者：
Luce, JM
中科院分区：
文献类型：
--
作者：
Prendergast, TJ;Luce, JM
为了确定生命维持护理的限制是否变得越来越普遍，我们试图量化建议暂停或撤销危重患者生命支持的发生率，描述患者对这些建议的反应，并研究如何解决这些建议的冲突。在1992年和1993年，我们前瞻性地从两个重症监护病房（ICU）连续招募了179名患者，对他们提出了暂停或撤回生命支持的建议。在可能的情况下，我们将结果与1987年和1988年在相同单位收集的类似时间段的数据进行了比较。在1992年和1993年，200例死亡中有179例（90%）在建议暂停或撤销生命支持之前死亡，而在1987年和1988年，224例死亡中有114例（51%）在建议暂停或撤销生命支持之前死亡（chi（2）= 73.76，p < 0.001）。在1992年和1993年，10%的死亡者进行了心肺复苏，而1987年和1988年为49%。90%的患者在不到5天内同意，只有8例患者（4%）拒绝医生的建议，以限制生命支持。在发生冲突的情况下，1992年和1993年的医生都听从病人的意见，但有一个例外：医生愿意拒绝他们认为病入膏肓的病人提出的复苏请求。我们的结论是，90%的病人谁死在这些ICU现在这样做后，决定限制治疗，这代表了一个重大的变化，在实践中，这些机构在5年的时间，大多数患者和代理人接受适当的建议，以扣留或撤回生命支持，医生会拒绝代理请求在某些情况下。
To determine whether limits to life-sustaining care are becoming more common, we attempted to quantify the incidence of recommendations to withhold or withdraw life support from critically ill patients, to describe how patients respond to these recommendations, and to examine how conflicts over these recommendations are resolved. In 1992 and 1993 we prospectively enrolled 179 consecutive patients from two intensive care units (ICUs) for whom a recommendation was made to withhold or withdraw life support. Where possible, we compared results with data collected in the same units over a similar time period in 1987 and 1988. Recommendations to withhold or withdraw life support preceded 179 of 200 deaths (90%) in 1992 and 1993, compared with 114 of 224 deaths (51%) in 1987 and 1988 (chi(2) = 73.76, p < 0.001]. Cardiopulmonary resuscitation was initiated in 10% of deaths in 1992 and 1993 as compared with 49% in 1987 and 1988. Ninety percent of patients agreed within less than 5 d, and only eight patients (4%) refused physicians' recommendations to limit life support. In cases of conflict, physicians in 1992 and 1993 deferred to patients with one exception: physicians were willing to refuse surrogate requests for resuscitation of patients they considered hopelessly ill. We conclude that 90% of patients who die in these ICUs now do so following a decision to limit therapy, that this represents a major change in practice in these institutions over a period of 5 yr, that most patients and surrogates accept an appropriate recommendation to withhold or withdraw life support, and that physicians will refuse surrogate requests in certain circumstances.